Nonocclusive Mesenteric Ischemia: A Review for Interventional Radiologists

Abstract

Nonocclusive mesenteric ischemia (NOMI) is a condition characterized by segmental or discontinuous mesenteric ischemia and intestinal necrosis without an organic obstruction in the mesenteric vessels. Diagnosis is challenging, and early intervention is crucial for improving patient outcomes. Various factors such as background factors, symptoms, biomarkers, and imaging techniques contribute to the diagnosis. Ensuring an early diagnosis and prompt treatment is of paramount importance. Although studies reported on the effectiveness of intra-arterial vasodilator infusion therapy as an endovascular treatment, its future role remains uncertain. Therefore, this review primarily aimed to provide a comprehensive summary of the advancements in the current state of NOMI management, with a specific emphasis on the implementation of endovascular therapy.

Keywords: NOMI; contrast-enhanced CT; intra-arterial infusion therapy; nonocclusive mesenteric ischemia.

Figure 1.

A male in his 30s with NOMI. These figures were reproduced from reference 42. The authors received approval from the Japanese Society of Interventional Radiology (JSIR). a, b: Axial (a) and coronal (b) contrast-enhanced CT images showed edematous bowel wall changes. c: Angiography of the superior mesenteric artery showed poor bowel enhancement.

Figure 2.

A male in his 60s with NOMI. These figures were reproduced from reference 42. The authors received approval from the Japanese Society of Interventional Radiology (JSIR). a: An axial contrast-enhanced CT image revealed portal venous gas. b, c: Axial (b) and coronal (c) contrast-enhanced CT images showed poor mucosal enhancement and edematous bowel wall changes. d, e: Angiography of superior mesenteric artery pre- (d) and post (e) intra-arterial vasodilator infusion therapy. Preangiography (d) showed irregularities in the intestinal branches and arcade spasms with no contrast within the intramural vessels of the bowel. Postangiography (e) showed markedly improved intramural vessel filling. f, g: Axial (f) and coronal (g) CT during superior mesenteric arteriogram images showed the disappearance of portal venous gas and improved visualization of intramural vessels. h, i: Pre- (h) and posttreatment (i) coronal CT images demonstrate improved intramural vessel visualization.